Provider Demographics
NPI:1073894440
Name:WOOD, CAROL ANN (MFT)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:ANN
Last Name:WOOD
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2723 CROW CANYON RD
Mailing Address - Street 2:SUITE 209-B
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-1583
Mailing Address - Country:US
Mailing Address - Phone:925-785-8402
Mailing Address - Fax:925-830-9495
Practice Address - Street 1:2723 CROW CANYON RD
Practice Address - Street 2:SUITE 209-B
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1583
Practice Address - Country:US
Practice Address - Phone:925-785-8402
Practice Address - Fax:925-830-9008
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-30
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA35228101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA35228OtherBOARD OF BEHAVIORAL SCIENCES